More than 400 charged in America’s “largest healthcare fraud takedown”

Zayani Bhatt, 18 Jul 2017

It is hoped that the operation will improve the lives of American addicts.

One American dies of a drug overdose every 11 minutes and more than two million are addicted to prescription painkillers. Much of this drug crisis is due to opioid addiction. According to the Centers for Disease Control and Prevention (CDCP), 91 Americans die from opioid overdose every day.

The Department of Justice and the Department of Health and Human Services (HHS) in America have undertaken an eight-year-long national takedown of the country’s opioid criminals. Said to be the “largest ever healthcare fraud enforcement action” in American history, 115 doctors, nurses and other medical professionals were charged with defrauding taxpayers of USD1.3 billion on the 14 July 2017.

Of the total 412 defendants, 120 have been charged with issuing prescriptions when not necessary, overprescribing and billing government health services fraudulently.

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Director General Jeff Sessions said.

“Amazingly, some have made their practices into multimillion-dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.”

Surprisingly, the elderly are some of the worst affected

Of these 120, six of the doctors were charged with conducting a scheme in the American state of Michigan in which the drugs they unnecessarily prescribed were subsequently sold on the street. This scheme cost the government’s health insurance programme for over 65’s (Medicare), USD164 million in fraudulent claims.

The scheme allows elderly and disabled patients to request opioid drugs on prescription but a report from the Inspector General Daniel R. Levinson showed that almost 70,000 have received 240mg of morphine every day for the entire year. This is extremely high when compared than the standard set by the CDCP – no more than 90mg per day. More than 15,000 of such patients died from overdose in 2015.

With the call to use less opioids, the elderly with chronic pain have pushed back saying they need them to function. In order to obtain these high levels, 22,000 were caught “doctor shopping”. The most common drugs were Tramadol and pills containing hydrocodone or oxycodone.

A report by a government watchdog said that, “although beneficiaries may receive opioids from multiple prescribers or pharmacies for legitimate reasons, these patterns raise concern.” The concerns are that many patients are selling the drugs they are prescribed.

Even those designed to protect addicts, are failing

Despite this, the crisis predominantly affects 25 to 44 year-olds. For example, a clinic in Houston has allegedly handed out 12,000 opioid prescriptions in exchange for cash.

Some doctors have written more prescriptions for controlled substances in one month than entire hospitals have. However it is not just doctors, rehabilitation centres are succumbing too.

One in Florida is alleged to have recruited addicts with gift cards, drugs and visits to strip clubs and charged the government over USD58 million in the name of false treatments and tests.

Additionally, there is a whole industry of ‘brokers’ who earn tens of thousands of dollars from arranging transport and insurance of drugs to rehab centers.

US government is determined to stop the crisis from worsening

Sessions has modeled his approach on President Ronald Reagan’s during the 1980’s. Aided by President Trump’s increase in investment in the Fraud and Abuse Control Program, Sessions has a three pronged approach: prevention, cutting distribution and providing treatment options.

In order to tackle this mass operation, the Federal Bureau of Investigation (FBI) has provided 29 of its 56 field office locations and the Drug Enforcement Agency and HSS have provided resources and officials. In total, there were more than 1,000 law enforcement personnel across 30 states.

Despite this, the majority of charges have come from tip-offs from community members and according to Sessions from “very sophisticated computer programs that identify outliers.”

"We are sending a clear message to criminals across the country: we will find you. We will bring you to justice. And, you will pay a very high price for what you have done," Sessions said.

Protecting federal health programmes such as Medicare and Medicaid are not the only aims of the operation. Increasing access to anti-overdose drugs, backing research into more anti-addiction treatments and identifying the social conditions that facilitate the spread of addiction are some of the factors the HHS are focusing on.

The FDA is also looking into the public health implications of new opioid treatments. Additionally, almost every state has created a database, which prescribers are required to check for signs of drug abuse or doctor shopping and many authorities believe that these monitoring programs are helping to curb the practices.

Some organisations are also looking into improving treatment available to addicts and many have recommended the authorisation of needles and sale and distribution of syringes. MIMS

Are overlapping surgeries putting patients at risk?
20 hours ago
A new study has added to the ever-increasing body of work that suggests patients of overlapping surgeries are more likely to suffer serious complications compared to surgeries in which the doctor focuses just on one patient. Nonetheless, is this study more credible?